Neurogenic bowel treatments and continence outcomes in children and adults with myelomeningocele.

PURPOSE: Neurogenic bowel dysfunction (NBD) is a common comorbidity of myelomeningocele (MMC), the most common and severe form of spina bifida. The National Spina Bifida Patient Registry (NSBPR) is a research collaboration between the CDC and Spina Bifida Clinics. Fecal continence (continence) outcomes for common treatment modalities for NBD have not been described in a large sample of individuals with MMC. NSBPR patients with MMC and NBD were studied to determine variation in continence status and their ability to perform their treatment independently according to treatment modality and individual characteristics. METHODS: Continence was defined as < 1 episode of incontinence per month. Eleven common treatments were evaluated. Inclusion criteria were established diagnoses of both MMC and NBD, as well as age ⩾ 5 years (n= 3670). Chi-square or exact statistical tests were used for bivariate analyses. Logistic regression models were used to estimate the odds of continence outcomes by age, sex, race/ethnicity, level of motor function, and insurance status. RESULTS: At total of 3670 members of the NSBPR met inclusion criteria between November 2013 and December 2017. Overall prevalence of continence was 45%. Prevalence ranged from 40-69% across different treatments. Among continent individuals, 60% achieved continence without surgery. Antegrade enemas were the most commonly used treatment and had the highest associated continence rate. Ability to carry out a treatment independently increased with age. Multivariable logistic regression showed significantly higher odds of continence among individuals aged ⩾ 12 years, female, non-Hispanic white, and with private insurance.

Patients' cultural and spiritual explanatory models in health encounters: a focus on the efficacy of cancer prevention strategies in women from South Sudan.

This qualitative study examined non-clinical factors that affect health, namely the cultural and spiritual beliefs of the patient. The study focuses on women from South Sudan. Although the overt religious adherence of these women is familiar to mainstream Australia (i.e. Christian), they are culturally diverse from the mainstream. The experiences of five women were documented. These women, all regarded as community leaders, were also asked about their assessment of the views of the wider community of women from South Sudan. This study informs targeted health promotion messages for a significant community in Australia. It is anticipated that the findings of this research, although not generalisable to the whole South Sudanese community or to all those with a refugee background, will provide important information to guide the development of culturally appropriate health care into the future. The findings point to the need for enhanced clinical education around communication, especially in relation to understanding the patients' explanatory models of health. The findings have implications for patient education strategies. Finally, the findings reinforce the importance of engaging the community in the development of those strategies and ensuring their input into further research.